|
EXC H-F-NK-SP B9+MARG 0.6-1
|
Professional
|
Both
|
$1,003.00
|
|
|
Service Code
|
CPT 11421
|
| Hospital Charge Code |
9601142101
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$104.19 |
| Max. Negotiated Rate |
$942.82 |
| Rate for Payer: Aetna of VT Commercial |
$942.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$898.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$107.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$898.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$145.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$219.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$219.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$119.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$219.90
|
| Rate for Payer: Cash Price |
$501.50
|
| Rate for Payer: Cash Price |
$501.50
|
| Rate for Payer: Cigna Commercial |
$117.04
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$245.83
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$245.83
|
| Rate for Payer: Martins Point Health Care Commercial |
$151.41
|
| Rate for Payer: Multiplan Commercial |
$932.79
|
| Rate for Payer: MVP Health Care of NY Commercial |
$147.95
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$104.19
|
| Rate for Payer: United Healthcare Commercial |
$160.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$104.19
|
| Rate for Payer: United Healthcare VA CCN |
$104.19
|
|
|
EXC H-F-NK-SP B9+MARG 0.6-1
|
Facility
|
IP
|
$1,003.00
|
|
|
Service Code
|
CPT 11421
|
| Hospital Charge Code |
9601142101
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$742.32 |
| Max. Negotiated Rate |
$952.85 |
| Rate for Payer: Aetna of VT Commercial |
$952.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$742.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$742.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$852.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$842.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$802.40
|
| Rate for Payer: Cash Price |
$501.50
|
| Rate for Payer: Cigna Commercial |
$802.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$802.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$802.40
|
| Rate for Payer: Multiplan Commercial |
$932.79
|
| Rate for Payer: MVP Health Care of NY Commercial |
$852.55
|
| Rate for Payer: United Healthcare Commercial |
$952.85
|
|
|
EXC H-F-NK-SP B9+MARG 0.6-1
|
Professional
|
Both
|
$423.00
|
|
|
Service Code
|
CPT 11421
|
| Hospital Charge Code |
9601142102
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$104.19 |
| Max. Negotiated Rate |
$397.62 |
| Rate for Payer: Aetna of VT Commercial |
$397.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$378.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$107.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$378.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$145.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$219.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$219.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$119.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$219.90
|
| Rate for Payer: Cash Price |
$211.50
|
| Rate for Payer: Cash Price |
$211.50
|
| Rate for Payer: Cigna Commercial |
$117.04
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$245.83
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$245.83
|
| Rate for Payer: Martins Point Health Care Commercial |
$151.41
|
| Rate for Payer: Multiplan Commercial |
$393.39
|
| Rate for Payer: MVP Health Care of NY Commercial |
$147.95
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$104.19
|
| Rate for Payer: United Healthcare Commercial |
$160.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$104.19
|
| Rate for Payer: United Healthcare VA CCN |
$104.19
|
|
|
EXC H-F-NK-SP B9+MARG 0.6-1
|
Facility
|
OP
|
$423.00
|
|
|
Service Code
|
CPT 11421
|
| Hospital Charge Code |
9601142102
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$187.35 |
| Max. Negotiated Rate |
$401.85 |
| Rate for Payer: Aetna of VT Commercial |
$401.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$378.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$187.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$378.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$254.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$359.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$342.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$190.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$336.29
|
| Rate for Payer: Cash Price |
$211.50
|
| Rate for Payer: Cigna Commercial |
$338.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$338.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$338.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$190.35
|
| Rate for Payer: Multiplan Commercial |
$393.39
|
| Rate for Payer: MVP Health Care of NY Commercial |
$359.55
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$190.35
|
| Rate for Payer: United Healthcare Commercial |
$401.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$190.35
|
| Rate for Payer: United Healthcare VA CCN |
$190.35
|
|
|
EXC H-F-NK-SP B9+MARG 0.6-1
|
Facility
|
OP
|
$580.00
|
|
|
Service Code
|
CPT 11421
|
| Hospital Charge Code |
5101142101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$256.88 |
| Max. Negotiated Rate |
$551.00 |
| Rate for Payer: Aetna of VT Commercial |
$551.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$519.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$256.88
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$519.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$349.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$493.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$469.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$261.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$461.10
|
| Rate for Payer: Cash Price |
$290.00
|
| Rate for Payer: Cigna Commercial |
$464.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$464.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$464.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$261.00
|
| Rate for Payer: Multiplan Commercial |
$539.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$493.00
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$261.00
|
| Rate for Payer: United Healthcare Commercial |
$551.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$261.00
|
| Rate for Payer: United Healthcare VA CCN |
$261.00
|
|
|
EXC H-F-NK-SP B9+MARG 0.6-1
|
Professional
|
Both
|
$580.00
|
|
|
Service Code
|
CPT 11421
|
| Hospital Charge Code |
5101142101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$104.19 |
| Max. Negotiated Rate |
$545.20 |
| Rate for Payer: Aetna of VT Commercial |
$545.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$519.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$107.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$519.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$145.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$219.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$219.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$119.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$219.90
|
| Rate for Payer: Cash Price |
$290.00
|
| Rate for Payer: Cash Price |
$290.00
|
| Rate for Payer: Cigna Commercial |
$117.04
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$245.83
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$245.83
|
| Rate for Payer: Martins Point Health Care Commercial |
$151.41
|
| Rate for Payer: Multiplan Commercial |
$539.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$147.95
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$104.19
|
| Rate for Payer: United Healthcare Commercial |
$160.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$104.19
|
| Rate for Payer: United Healthcare VA CCN |
$104.19
|
|
|
EXC H-F-NK-SP B9+MARG 1.1-2
|
Facility
|
OP
|
$469.00
|
|
|
Service Code
|
CPT 11422
|
| Hospital Charge Code |
9821142201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$207.72 |
| Max. Negotiated Rate |
$445.55 |
| Rate for Payer: Aetna of VT Commercial |
$445.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$420.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$207.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$420.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$282.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$398.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$379.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$211.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$372.86
|
| Rate for Payer: Cash Price |
$234.50
|
| Rate for Payer: Cigna Commercial |
$375.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$375.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$375.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$211.05
|
| Rate for Payer: Multiplan Commercial |
$436.17
|
| Rate for Payer: MVP Health Care of NY Commercial |
$398.65
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$211.05
|
| Rate for Payer: United Healthcare Commercial |
$445.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$211.05
|
| Rate for Payer: United Healthcare VA CCN |
$211.05
|
|
|
EXC H-F-NK-SP B9+MARG 1.1-2
|
Facility
|
IP
|
$469.00
|
|
|
Service Code
|
CPT 11422
|
| Hospital Charge Code |
9811142202
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$347.11 |
| Max. Negotiated Rate |
$445.55 |
| Rate for Payer: Aetna of VT Commercial |
$445.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$347.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$347.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$398.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$393.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$375.20
|
| Rate for Payer: Cash Price |
$234.50
|
| Rate for Payer: Cigna Commercial |
$375.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$375.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$375.20
|
| Rate for Payer: Multiplan Commercial |
$436.17
|
| Rate for Payer: MVP Health Care of NY Commercial |
$398.65
|
| Rate for Payer: United Healthcare Commercial |
$445.55
|
|
|
EXC H-F-NK-SP B9+MARG 1.1-2
|
Facility
|
OP
|
$724.00
|
|
|
Service Code
|
CPT 11422
|
| Hospital Charge Code |
9601142201
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$320.66 |
| Max. Negotiated Rate |
$687.80 |
| Rate for Payer: Aetna of VT Commercial |
$687.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$648.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$320.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$648.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$435.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$615.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$586.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$325.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$575.58
|
| Rate for Payer: Cash Price |
$362.00
|
| Rate for Payer: Cigna Commercial |
$579.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$579.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$579.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$325.80
|
| Rate for Payer: Multiplan Commercial |
$673.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$615.40
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$325.80
|
| Rate for Payer: United Healthcare Commercial |
$687.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$325.80
|
| Rate for Payer: United Healthcare VA CCN |
$325.80
|
|
|
EXC H-F-NK-SP B9+MARG 1.1-2
|
Professional
|
Both
|
$469.00
|
|
|
Service Code
|
CPT 11422
|
| Hospital Charge Code |
9601142202
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$130.45 |
| Max. Negotiated Rate |
$440.86 |
| Rate for Payer: Aetna of VT Commercial |
$440.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$420.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$134.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$420.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$182.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$245.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$245.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$150.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$245.10
|
| Rate for Payer: Cash Price |
$234.50
|
| Rate for Payer: Cash Price |
$234.50
|
| Rate for Payer: Cigna Commercial |
$145.85
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$277.21
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$277.21
|
| Rate for Payer: Martins Point Health Care Commercial |
$170.28
|
| Rate for Payer: Multiplan Commercial |
$436.17
|
| Rate for Payer: MVP Health Care of NY Commercial |
$185.24
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$130.45
|
| Rate for Payer: United Healthcare Commercial |
$200.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$130.45
|
| Rate for Payer: United Healthcare VA CCN |
$130.45
|
|
|
EXC H-F-NK-SP B9+MARG 1.1-2
|
Facility
|
IP
|
$724.00
|
|
|
Service Code
|
CPT 11422
|
| Hospital Charge Code |
9601142201
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$535.83 |
| Max. Negotiated Rate |
$687.80 |
| Rate for Payer: Aetna of VT Commercial |
$687.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$535.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$535.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$615.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$608.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$579.20
|
| Rate for Payer: Cash Price |
$362.00
|
| Rate for Payer: Cigna Commercial |
$579.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$579.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$579.20
|
| Rate for Payer: Multiplan Commercial |
$673.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$615.40
|
| Rate for Payer: United Healthcare Commercial |
$687.80
|
|
|
EXC H-F-NK-SP B9+MARG 1.1-2
|
Facility
|
IP
|
$255.40
|
|
|
Service Code
|
CPT 11422
|
| Hospital Charge Code |
4501142201
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$189.02 |
| Max. Negotiated Rate |
$242.63 |
| Rate for Payer: Aetna of VT Commercial |
$242.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$189.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$189.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$217.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$214.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$204.32
|
| Rate for Payer: Cash Price |
$127.70
|
| Rate for Payer: Cigna Commercial |
$204.32
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$204.32
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$204.32
|
| Rate for Payer: Multiplan Commercial |
$237.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$217.09
|
| Rate for Payer: United Healthcare Commercial |
$242.63
|
|
|
EXC H-F-NK-SP B9+MARG 1.1-2
|
Facility
|
IP
|
$469.00
|
|
|
Service Code
|
CPT 11422
|
| Hospital Charge Code |
9811142201
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$347.11 |
| Max. Negotiated Rate |
$445.55 |
| Rate for Payer: Aetna of VT Commercial |
$445.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$347.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$347.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$398.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$393.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$375.20
|
| Rate for Payer: Cash Price |
$234.50
|
| Rate for Payer: Cigna Commercial |
$375.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$375.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$375.20
|
| Rate for Payer: Multiplan Commercial |
$436.17
|
| Rate for Payer: MVP Health Care of NY Commercial |
$398.65
|
| Rate for Payer: United Healthcare Commercial |
$445.55
|
|
|
EXC H-F-NK-SP B9+MARG 1.1-2
|
Facility
|
IP
|
$469.00
|
|
|
Service Code
|
CPT 11422
|
| Hospital Charge Code |
9601142202
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$347.11 |
| Max. Negotiated Rate |
$445.55 |
| Rate for Payer: Aetna of VT Commercial |
$445.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$347.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$347.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$398.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$393.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$375.20
|
| Rate for Payer: Cash Price |
$234.50
|
| Rate for Payer: Cigna Commercial |
$375.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$375.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$375.20
|
| Rate for Payer: Multiplan Commercial |
$436.17
|
| Rate for Payer: MVP Health Care of NY Commercial |
$398.65
|
| Rate for Payer: United Healthcare Commercial |
$445.55
|
|
|
EXC H-F-NK-SP B9+MARG 1.1-2
|
Professional
|
Both
|
$256.00
|
|
|
Service Code
|
CPT 11422
|
| Hospital Charge Code |
5101142201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$130.45 |
| Max. Negotiated Rate |
$277.21 |
| Rate for Payer: Aetna of VT Commercial |
$240.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$229.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$134.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$229.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$182.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$245.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$245.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$150.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$245.10
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cigna Commercial |
$145.85
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$277.21
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$277.21
|
| Rate for Payer: Martins Point Health Care Commercial |
$170.28
|
| Rate for Payer: Multiplan Commercial |
$238.08
|
| Rate for Payer: MVP Health Care of NY Commercial |
$185.24
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$130.45
|
| Rate for Payer: United Healthcare Commercial |
$200.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$130.45
|
| Rate for Payer: United Healthcare VA CCN |
$130.45
|
|
|
EXC H-F-NK-SP B9+MARG 1.1-2
|
Facility
|
OP
|
$256.00
|
|
|
Service Code
|
CPT 11422
|
| Hospital Charge Code |
5101142201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$113.38 |
| Max. Negotiated Rate |
$243.20 |
| Rate for Payer: Aetna of VT Commercial |
$243.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$229.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$113.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$229.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$154.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$217.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$207.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$115.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$203.52
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cigna Commercial |
$204.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$204.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$204.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$115.20
|
| Rate for Payer: Multiplan Commercial |
$238.08
|
| Rate for Payer: MVP Health Care of NY Commercial |
$217.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$115.20
|
| Rate for Payer: United Healthcare Commercial |
$243.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$115.20
|
| Rate for Payer: United Healthcare VA CCN |
$115.20
|
|
|
EXC H-F-NK-SP B9+MARG 1.1-2
|
Professional
|
Both
|
$469.00
|
|
|
Service Code
|
CPT 11422
|
| Hospital Charge Code |
9811142202
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$130.45 |
| Max. Negotiated Rate |
$440.86 |
| Rate for Payer: Aetna of VT Commercial |
$440.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$420.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$134.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$420.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$182.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$245.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$245.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$150.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$245.10
|
| Rate for Payer: Cash Price |
$234.50
|
| Rate for Payer: Cash Price |
$234.50
|
| Rate for Payer: Cigna Commercial |
$145.85
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$277.21
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$277.21
|
| Rate for Payer: Martins Point Health Care Commercial |
$170.28
|
| Rate for Payer: Multiplan Commercial |
$436.17
|
| Rate for Payer: MVP Health Care of NY Commercial |
$185.24
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$130.45
|
| Rate for Payer: United Healthcare Commercial |
$200.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$130.45
|
| Rate for Payer: United Healthcare VA CCN |
$130.45
|
|
|
EXC H-F-NK-SP B9+MARG 1.1-2
|
Professional
|
Both
|
$469.00
|
|
|
Service Code
|
CPT 11422
|
| Hospital Charge Code |
9811142201
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$130.45 |
| Max. Negotiated Rate |
$440.86 |
| Rate for Payer: Aetna of VT Commercial |
$440.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$420.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$134.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$420.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$182.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$245.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$245.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$150.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$245.10
|
| Rate for Payer: Cash Price |
$234.50
|
| Rate for Payer: Cash Price |
$234.50
|
| Rate for Payer: Cigna Commercial |
$145.85
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$277.21
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$277.21
|
| Rate for Payer: Martins Point Health Care Commercial |
$170.28
|
| Rate for Payer: Multiplan Commercial |
$436.17
|
| Rate for Payer: MVP Health Care of NY Commercial |
$185.24
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$130.45
|
| Rate for Payer: United Healthcare Commercial |
$200.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$130.45
|
| Rate for Payer: United Healthcare VA CCN |
$130.45
|
|
|
EXC H-F-NK-SP B9+MARG 1.1-2
|
Facility
|
OP
|
$469.00
|
|
|
Service Code
|
CPT 11422
|
| Hospital Charge Code |
9601142202
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$207.72 |
| Max. Negotiated Rate |
$445.55 |
| Rate for Payer: Aetna of VT Commercial |
$445.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$420.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$207.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$420.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$282.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$398.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$379.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$211.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$372.86
|
| Rate for Payer: Cash Price |
$234.50
|
| Rate for Payer: Cigna Commercial |
$375.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$375.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$375.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$211.05
|
| Rate for Payer: Multiplan Commercial |
$436.17
|
| Rate for Payer: MVP Health Care of NY Commercial |
$398.65
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$211.05
|
| Rate for Payer: United Healthcare Commercial |
$445.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$211.05
|
| Rate for Payer: United Healthcare VA CCN |
$211.05
|
|
|
EXC H-F-NK-SP B9+MARG 1.1-2
|
Professional
|
Both
|
$724.00
|
|
|
Service Code
|
CPT 11422
|
| Hospital Charge Code |
9601142201
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$130.45 |
| Max. Negotiated Rate |
$680.56 |
| Rate for Payer: Aetna of VT Commercial |
$680.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$648.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$134.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$648.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$182.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$245.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$245.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$150.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$245.10
|
| Rate for Payer: Cash Price |
$362.00
|
| Rate for Payer: Cash Price |
$362.00
|
| Rate for Payer: Cigna Commercial |
$145.85
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$277.21
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$277.21
|
| Rate for Payer: Martins Point Health Care Commercial |
$170.28
|
| Rate for Payer: Multiplan Commercial |
$673.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$185.24
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$130.45
|
| Rate for Payer: United Healthcare Commercial |
$200.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$130.45
|
| Rate for Payer: United Healthcare VA CCN |
$130.45
|
|
|
EXC H-F-NK-SP B9+MARG 1.1-2
|
Facility
|
IP
|
$469.00
|
|
|
Service Code
|
CPT 11422
|
| Hospital Charge Code |
9821142201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$347.11 |
| Max. Negotiated Rate |
$445.55 |
| Rate for Payer: Aetna of VT Commercial |
$445.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$347.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$347.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$398.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$393.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$375.20
|
| Rate for Payer: Cash Price |
$234.50
|
| Rate for Payer: Cigna Commercial |
$375.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$375.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$375.20
|
| Rate for Payer: Multiplan Commercial |
$436.17
|
| Rate for Payer: MVP Health Care of NY Commercial |
$398.65
|
| Rate for Payer: United Healthcare Commercial |
$445.55
|
|
|
EXC H-F-NK-SP B9+MARG 1.1-2
|
Facility
|
OP
|
$469.00
|
|
|
Service Code
|
CPT 11422
|
| Hospital Charge Code |
9811142202
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$207.72 |
| Max. Negotiated Rate |
$445.55 |
| Rate for Payer: Aetna of VT Commercial |
$445.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$420.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$207.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$420.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$282.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$398.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$379.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$211.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$372.86
|
| Rate for Payer: Cash Price |
$234.50
|
| Rate for Payer: Cigna Commercial |
$375.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$375.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$375.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$211.05
|
| Rate for Payer: Multiplan Commercial |
$436.17
|
| Rate for Payer: MVP Health Care of NY Commercial |
$398.65
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$211.05
|
| Rate for Payer: United Healthcare Commercial |
$445.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$211.05
|
| Rate for Payer: United Healthcare VA CCN |
$211.05
|
|
|
EXC H-F-NK-SP B9+MARG 1.1-2
|
Professional
|
Both
|
$469.00
|
|
|
Service Code
|
CPT 11422
|
| Hospital Charge Code |
9821142201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$130.45 |
| Max. Negotiated Rate |
$440.86 |
| Rate for Payer: Aetna of VT Commercial |
$440.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$420.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$134.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$420.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$182.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$245.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$245.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$150.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$245.10
|
| Rate for Payer: Cash Price |
$234.50
|
| Rate for Payer: Cash Price |
$234.50
|
| Rate for Payer: Cigna Commercial |
$145.85
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$277.21
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$277.21
|
| Rate for Payer: Martins Point Health Care Commercial |
$170.28
|
| Rate for Payer: Multiplan Commercial |
$436.17
|
| Rate for Payer: MVP Health Care of NY Commercial |
$185.24
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$130.45
|
| Rate for Payer: United Healthcare Commercial |
$200.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$130.45
|
| Rate for Payer: United Healthcare VA CCN |
$130.45
|
|
|
EXC H-F-NK-SP B9+MARG 1.1-2
|
Facility
|
OP
|
$255.40
|
|
|
Service Code
|
CPT 11422
|
| Hospital Charge Code |
4501142201
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$113.12 |
| Max. Negotiated Rate |
$242.63 |
| Rate for Payer: Aetna of VT Commercial |
$242.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$228.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$113.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$228.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$153.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$217.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$206.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$114.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$203.04
|
| Rate for Payer: Cash Price |
$127.70
|
| Rate for Payer: Cigna Commercial |
$204.32
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$204.32
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$204.32
|
| Rate for Payer: Martins Point Health Care Commercial |
$114.93
|
| Rate for Payer: Multiplan Commercial |
$237.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$217.09
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$114.93
|
| Rate for Payer: United Healthcare Commercial |
$242.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$114.93
|
| Rate for Payer: United Healthcare VA CCN |
$114.93
|
|
|
EXC H-F-NK-SP B9+MARG 1.1-2
|
Facility
|
OP
|
$469.00
|
|
|
Service Code
|
CPT 11422
|
| Hospital Charge Code |
9811142201
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$207.72 |
| Max. Negotiated Rate |
$445.55 |
| Rate for Payer: Aetna of VT Commercial |
$445.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$420.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$207.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$420.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$282.34
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$398.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$379.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$211.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$372.86
|
| Rate for Payer: Cash Price |
$234.50
|
| Rate for Payer: Cigna Commercial |
$375.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$375.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$375.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$211.05
|
| Rate for Payer: Multiplan Commercial |
$436.17
|
| Rate for Payer: MVP Health Care of NY Commercial |
$398.65
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$211.05
|
| Rate for Payer: United Healthcare Commercial |
$445.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$211.05
|
| Rate for Payer: United Healthcare VA CCN |
$211.05
|
|
